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Screening patients with type 2 diabetes may prevent liver-related diseases

Researchers found that among a cohort of patients with type 2 diabetes, nonalcoholic fatty liver disease and advanced fibrosis were common, suggesting that noninvasive screening among patients with diabetes should be considered in a primary care setting to avoid liver-related complications.

“This is the first prospective study that assessed the feasibility of screening for both NAFLD and advanced fibrosis in type 2 diabetic patients in a primary care setting by using two accurate, precise validated noninvasive image-based biomarkers,” the researchers wrote. “The study cohort included a diverse population of patients with [type 2 diabetes] that has been managed and followed by primary care providers, and was conducted in the population likely to benefit from such screening program.”

Researchers, including Rohit Loomba, MD, MHSc, associate professor of clinical medicine, University of California San Diego, analyzed data of 100 patients with type 2 diabetes who did not have any form of liver disease. Each patient underwent laboratory tests, including magnetic resonance imaging-hepatic protein density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE).

Rohit Loomba

The primary endpoint of the study was to determine the feasibility of screening patients with diabetes for NAFLD via MRI for PDFF. The secondary endpoint was determining the feasibility of screening for advanced fibrosis via MRE.

“MRI-PDFF is a robust, accurate, precise, and reproducible quantitative biomarker of liver fat content,” Loomba told Healio.com/Hepatology. “MRE is a robust, accurate, precise and reproducible quantitative biomarker of liver stiffness as a surrogate of fibrosis content in NAFLD.”

Overall, the mean age was 59.7 years and mean BMI was 30.8 kg/m². The prevalence of NAFLD was 65% via MRI-PDFF and prevalence of advanced fibrosis was 7.1% via MRE. Patients with NAFLD were younger (P = .028) and had higher mean BMI (P = .0008), waist circumference (P < .0001) and prevalence of metabolic syndrome (84.6% vs. 40%; P < .0001) compared with patients without NAFLD. Only 26% of those with NAFLD had elevated alanine aminotransferase.

“We also found that the prevalence of HCC is approximately 1%,” Loomba said. “These data underscore the need to validate these findings in a larger multicenter study that would trigger the change in practice by screening type 2 diabetics for advanced liver disease.”

The researchers concluded: “Concomitant screening for NAFLD and advanced fibrosis by using [MRI-PDFF] and [MRE] in [type 2 diabetes mellitus] is feasible and may be considered after validation in a larger cohort.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.